Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Wagner, Jeffrey D.; Davidson, Darrell D.; Coleman, John J.; Hutchins, G M; Schauwecker, Donald S.; Park, Hee Myung; Havlik, Robert J.

doi:10.1007/s10434-999-0398-4

Cited by 83 publications

(37 citation statements)

References 15 publications

(24 reference statements)

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“…In our series, the pattern of metastasis size was similar to that reported by other authors [21], with 13 micrometastases (less than 2 mm in diameter) out of 31 positive basins (45%) ( Table III).…”

Section: Discussionsupporting

confidence: 88%

The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients

Róssi¹,

Mocellin²,

Scagnet³

et al. 2003

Journal of Surgical Oncology

106

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Section: Discussionsupporting

confidence: 88%

The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients

Róssi¹,

Mocellin²,

Scagnet³

et al. 2003

Journal of Surgical Oncology

106

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“…11,29 The approach of using micrometric assessment of metastatic tumor diameter has been profitably developed by Starz et al, 30,31 in Augsburg, and alone or in combination with determination of the number of 1-mm-thick slices of the sentinel nodes that contain tumor applied to the evaluation of sentinel nodes. The use of ocular micrometers to evaluate the diameter of metastases in sentinel node has also been reported by Wagner et al, 32 and Ranieri et al 33 We are currently collaborating with the Augsburg group to compare the predictive value of area measurements of nodal tumor with the information obtainable by evaluation of the micrometer-measured maximum diameter nodal tumor. If the micrometer approach provides guidance comparable to the tumor predictive accuracy of tumor area assessment, it would be preferable as a relatively simple approach since the technique is already widely used in routine anatomic pathology evaluation.…”

Section: Discussionmentioning

confidence: 65%

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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Lymphatic mapping and sentinel node biopsy are well-established techniques for staging and managing patients with melanoma, breast cancer and other malignancies that spread initially to the regional lymph nodes. Identification of tumor in the sentinel node is the most precise staging technique currently available. The sentinel node is the site of metastatic melanoma in approximately 20% of melanoma patients and if tumor is present in the sentinel node it is customary to perform a complete dissection of the lymph nodes of the affected nodal basin. This may be overtreatment for some patients as tumor is identified in the nonsentinel nodes of only one-third of sentinel node-positive melanoma patients treated by completion lymphadenectomy. If it were possible accurately to identify the minority of patients with tumor in the nonsentinel nodes, the patients most likely to benefit from lymphadenectomy, the remaining patients could be spared a potentially morbid operation that is unlikely to confer clinical advantage. In 90 patients with a melanoma-positive sentinel node, who subsequently had a completion lymphadenectomy, we evaluated and compared the capacity of characteristics of the primary melanoma and of the sentinel node to predict individuals likely to have tumor in nonsentinel nodes. We assessed the Breslow thickness of the primary, the amount of tumor in the sentinel node (relative tumor area) and, as an index of immune modulation of the sentinel node, the density of dendritic leukocytes in the nodal paracortex. The relative area of tumor in the sentinel node and Breslow thickness of the primary melanoma most accurately predicted the presence of tumor in the nonsentinel nodes (P ¼ 0.0001 in both cases-Wilcoxon rank sums). The presence of melanoma in the nonsentinel nodes was also predicted by the density of dendritic leukocytes in the paracortex (P ¼ 0.008-Wilcoxon rank sums). These three observations assessed alone and in combination predict the presence of tumor in the nonsentinel nodes with high accuracy. The same characteristics also significantly correlated with tumor recurrence (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0.0007) and death from melanoma (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0. Keywords: melanoma; sentinel node; tumor burden; immune suppression; tumor recurrence; melanoma deathThe techniques of lymphatic mapping and sentinel node biopsy were developed to improve the management of patients with high-risk (thick and deep) primary melanoma with a high potential for metastases, but no clinical evidence of metastatic spread.

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“…Nevertheless, the extent of tumor involvement in a sentinel lymph node should be noted (and measured where possible) to examine whether future subgroups should account for this, which has been suggested by some investigators. 44 With the availability of immunohistochemical staining, it is now possible to detect nodal metastases at a level of less than 0.1 mm in tumors or even aggregates of a few cells. 45 The reverse transcriptase polymerase chain reaction technique may even be able to detect metastases not identified by the light microscope.…”

mentioning

confidence: 99%

Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma

Balch

Buzaid

Soong

et al. 2001

JCO

2,354

1,559

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F i n a l V e r s i o n o f t h e A m e r i c a n J o i n t C o m m i t t e e o n C a n c e r S t a g i n g S y s t e m f o r C u t a n e o u s M e l a n o m aByMaterials and Methods: The prognostic factors analysis described in the companion publication (this issue), as well as evidence from the published literature, was used to assemble the tumor-node-metastasis criteria and stage grouping for the melanoma staging system.Results: Major changes include (1) melanoma thickness and ulceration but not level of invasion to be used in the T category (except for T1 melanomas); (2) the number of metastatic lymph nodes rather than their gross dimensions and the delineation of clinically occult (ie, microscopic) versus clinically apparent (ie, macroscopic) nodal metastases to be used in the N category; (3) the site of distant metastases and the presence of elevated serum lactic dehydrogenase to be used in the M category; (4) an upstaging of all patients with stage I, II, and III disease when a primary melanoma is ulcerated; (5) a merging of satellite metastases around a primary melanoma and in-transit metastases into a single staging entity that is grouped into stage III disease; and (6) a new convention for defining clinical and pathologic staging so as to take into account the staging information gained from intraoperative lymphatic mapping and sentinel node biopsy. T HE AMERICAN JOINT Committee on Cancer (AJCC)has now formally approved the final version of a revised melanoma staging system, which is described herein, along with operational definitions. The final version is similar to the initial recommendations from the AJCC Melanoma Staging Committee published last year.1 Subsequent to the published recommendations, a number of clinicians made comments and recommendations to members of the AJCC Melanoma Staging Committee. In addition, a major database analysis of prognostic factors involving 17,600 patients from 13 cancer centers and organizations was performed to validate the original proposal.2 Results from the prognostics factors analyses, as well as input from melanoma clinicians, were used by the AJCC Melanoma Staging Committee to make final adjustments to the melanoma staging system, changes that largely impacted the stage grouping criteria. The AJCC Executive Committee has approved the final version of the melanoma staging system. It will become official with publication of the sixth edition of the AJCC Cancer Staging Manual in the year 2002.The AJCC Melanoma Staging Committee used the following guidelines to determine which criteria should be used in the tumor-node-metastasis (TNM) classification and the stage groupings. First, the staging system must be practical, reproducible, and applicable to the diverse needs of all medical disciplines. Second, the criteria must accurately reflect the biology of melanoma based on consistent outcome results of patients treated at multiple institutions from multiple countries. Third, the criteria used must be evidence-based and reflect the dominant prognostic factors cons...

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Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Abstract: Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs.

Cited by 83 publications

References 15 publications

The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients

The role of preoperative ultrasound scan in detecting lymph node metastasis before sentinel node biopsy in melanoma patients

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma

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